Cardiac arrest incidence in Oregon dropped after Medicaid expansion

After Oregon expanded its Medicaid program in 2014, cardiac arrests significantly dropped among newly covered residents around Portland, according to a new study.

The number of out-of-hospital cardiac arrests in among people age 45-64 in Multnomah County, Ore., dropped by 17% after Medicaid expansion, researchers said in a new study published in the Journal of the American Heart Association. The county, which includes Portland, Oregon's largest city, has about 290,800 residents.

Lower incidence of cardiac arrest likely occurred because those with insurance are more likely to receive routine, preventive care that can mitigate their risks for cardiac disease as well as cardiac arrest, said Dr. Sumeet Chugh, an author of the study and associate director of the Heart Institute at Cedars-Sinai in Los Angeles.

"There is no question that having health insurance leads to a better quality of life and lower mortality, overall," Chugh said. "If you take a severe condition like cardiac arrest, that is mostly lethal, health insurance makes a difference."

Cardiac arrest is the leading cause of unexpected death in the U.S. and affects about 320,000 people per year, according to the American Heart Association. The fatality rate of an out-of-hospital cardiac arrest is also incredibly high, at about 70% to 90%.

The authors chose to focus on Oregon because the state adopted Medicaid expansion earlier, and the state had a study on sudden unexpected deaths that provided comprehensive details on cardiac arrest incidents in the Portland area.

More middle-aged Multnomah County residents acquired health insurance through Medicaid than other means, with an approximate 6.5 percentage-point increase after Medicaid expansion, from 7% to 13.5%. Insurance through direct-purchasing rose from 8.2% to 10% in the same period.

Although middle-aged individuals saw a drop in out-of-hospital cardiac arrests, those over age 65 didn't see a similar decline, the study found. This is likely because that population benefits from near-universal coverage under Medicare, Chugh said.

It's difficult to know whether other areas saw similar benefits to Medicaid expansion, and Chugh said more research will shed light on the impact insurance can have on patient health.

Medicaid expansion is one of the hot topics under debate as the Senate revises its bill to repeal and replace the Affordable Care Act. The Better Care Reconciliation Act proposes to roll back Medicaid expansion, and the Congressional Budget Office says the plan will leave 22 million more people uninsured by 2026. That has become a sticking point for lawmakers, patient advocacy groups and providers.

"Studies like this should be considered as these very important decisions are in the process of being made," Chugh said.